AMA CPT® Assistant - 2014 Issue 4 (April)

Surgery: Integumentary System (Q&A) (April 2014)

April 2014 page 10a Surgery: Integumentary System Question: Following a lumpectomy by a general surgeon, the plastic surgeon performs a Wise pattern breast reduction on the affected breast and a breast reduction on the opposite breast. Is it appropriate to report code 19318, Reduction mammaplasty, with modifier 50 appended, or code 19366, Breast reconstruction with other technique, also with modifier 50 appended? Answer: The surgery performed on each breast is a breast reduction; neither one is a reconstruction. Code 19318, Reduction mammaplasty, should be reported with modifier 50, Bilateral Procedure, appended. It is not appropriate to report code 19366...

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CPT® Assistant content is the official source for CPT® coding guidance. It is an instrumental tool when appealing insurance denials and validating coding to auditors. Monthly issues and an extensive archive provide comprehensive guidance on proper CPT® coding for past, present and upcoming code set releases. Archives date back to 1990 for historical use of codes, changes, rationales, coding tips and trends in the industry.

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